Evaluation of the pediatric Bonfils fiberscope for elective endotracheal intubation.
BACKGROUND
Difficult airway management in children is a particular challenge for anesthesiologists and pediatricians. This study was designed to evaluate the performance of the recently developed pediatric versions of the Bonfils fiberscope for elective endotracheal intubation during routine surgical procedures.


METHODS
After approval by the institutional review board and written informed consent, 55 children (age 6 +/- 4 years) scheduled for elective minor surgical procedures were enrolled. Nineteen children received atropine before the intubation attempt, while in the remaining 36 children, no antisialogogue was used. For endotracheal tubes up to 3.5 mm internal diameter, a fiberscope with outer diameter (OD) 2 mm, and for larger endotracheal tubes, a fiberscope OD 3.5 mm was used. Time to intubation and failure rate were obtained.


RESULTS
In the 36 children without and the 19 children with atropine pretreatment, the success rate for tracheal intubation on the first attempt was 69%/78% (25/15 patients). 4/3 patients and 2/0 patients were intubated after two and three attempts, respectively, and in 5/1 patients (14%/5%) intubation failed even after three attempts. Time to intubation was median 58/60 s, 25th-75th percentile 35-100/32-110 s, and range 14-377/18-360 s. In both groups, failed intubations were because of the secretions contaminating the optic aperture.


CONCLUSIONS
High failure rate and increased intubation times suggest that the pediatric Bonfils fiberscope has significant drawbacks when used for intubation of normal pediatric airways.
Bein
Berthold
B
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany. bein@anesthesie.uni-kiel.de
Wortmann
Frank
F
Meybohm
Patrick
P
Steinfath
Markus
M
Scholz
Jens
J
Dörges
Volker
V
D002648:Child; D017558:Elective Surgical Procedures; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D008297:Male; D013997:Time Factors; D017211:Treatment Failure